Care Home: The Old Rectory

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: The Old Rectory The Old Rectory Singleton Chichester West Sussex PO18 0HF one star adequate service The quality rating for this care home is: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Annette Campbell-Currie Date: 2 5 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to:  Put the people who use social care first  Improve services and stamp out bad practice  Be an expert voice on social care  Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Internet address www.csci.org.uk Information about the care home Name of care home: Address: The Old Rectory The Old Rectory Singleton Chichester West Sussex PO18 0HF 01243811482 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : clive.lucas@dignitygroup.net Dignity Group Ltd care home 27 Number of places (if applicable): Under 65 Over 65 27 0 learning disability Additional conditions: The registered person may provide the following category/ies of service only: Care home only - PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - LD The maximum number of service users who can be accommodated is: 27 Date of last inspection A bit about the care home The Old Rectory is registered to accommodate twenty seven younger adults with learning disabilities. The current registration allows current service users who reach the age of 65 to continue living at the home. The Old Rectory is set in extensive grounds and gardens within the quiet village of Singleton. The accommodation is split into four sections within two buildings; the Old Rectory, Rafters and the Garden Flat are within the main house. Segal House is a separate bungalow within the grounds that accommodates service users with more severe disabilities or challenging behaviour. The Dignity Group Ltd privately owns the service. The person acting on behalf of the organisation is Mr Tim Salmon. The registered manager responsible for the day to day running of the home is Mr Clive Lucas. Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home How we did our inspection: This is what the inspector did when they were at the care home The previous key unannounced inspection was carried out on 27th March 2007 and an Annual Service Review (ASR) was carried out on 27th February 2008. The current fees are from five hundred and ninety-seven pounds sixty-two pence and two thousand two hundred and fifty seven pounds and forty-seven pence per week. Annette Campbell-Currie carried out the site visit over six hours. The registered manager has just returned from an extended period of leave and was available to assist with the start of the inspection. The deputy manager who has been acting site manager in Mr Lucas absence and two team leaders also assisted with the inspection. Mr Salmon, the responsible individual for the company was available for discussion and feedback. There were twenty-one people living in the home at the time. The site manager completed an annual quality assurance assessment form (AQAA) before the inspection. The AQAA did not provide detailed information to help us (the Commission) plan the site visit. Some people were out at day centres, college courses or on outings with their key workers. During the site visit most of the people who were at home were seen and three people were spoken with. Time was also spent with five staff. Surveys were sent out to people living in the home, staff and health and social care professionals, to find out what people think about the service. Five of the people living in the home returned surveys with help from staff: six staff and one healthcare professional also returned surveys. The information gathered has been used to help make an assessment of the service. A tour of the four parts of the home included communal areas, the kitchens, laundries, bathrooms and toilet facilities and a number of bedrooms. The following documents were read: the case records of three people living in the home, the complaints policy and procedure, recruitment records for three recently appointed staff, training records, and a sample of medication records. The outcomes for people living in the home have been assessed in relation to twenty-three of the forty-three National Minimum Standards for Care Homes for Younger Adults: including those considered to be key standards to ensure the welfare of people living in the home. What the care home does well People living at The Old Rectory are supported in developing and maintaining independence skills and are provided with opportunities to take part in learning and leisure activities that they enjoy. There is an emphasis on helping people to use community facilities and to have a community presence. The atmosphere in the main house was relaxed and homely. The staff spoken with said they understand peoples needs and there were examples to show that people are supported in their independence as much as possible. Staff were observed during the day to be providing care in an appropriate and sensitive manner. There are comfortable communal spaces in the main building and well-maintained gardens for people to enjoy. Daytime activities in the home are also provided in two buildings in the grounds. Staff who returned surveys said that they are usually well supported by their line manager. There is an induction programme that includes elements of learning about working with people who have a learning disability. Staff are provided with mandatory training and updates as required. What has got better from the last inspection No requirements were made at the previous inspection. The storage of medication in Segal House has been reviewed and is now more secure. The site manager said in the AQAA that all staff have received additional medication training and that the introduction of his post has helped to improve communication with local authorities and better networking with external services. What the care home could do better Requirements have been made regarding the following matters: The home must ensure that the preassessment process is robust and recorded to show how decisions are made about whether or not the home could meet each persons needs. Holistic and person centred care plans must be drawn up for each person to make sure that their assessed and changing needs are met. Risk assessments must be carried out and guidance provided to staff to minimise risks to people living in the home and to themselves. Medication records must be kept in order and prescribed medication checked to make sure people are receiving the medication prescribed for them. Systems must be set up for recording and monitoring complaints to show that peoples complaints are being listened to and acted upon. All areas of the home must be kept clean and reasonably decorated to prevent the risk of cross infection and to provide a pleasant environment for people to live in. Materials that may be hazardous to health must be kept in a lockable facility in order to keep people safe from harm. The home must ensure that there is a robust recruitment process and two written references obtained before a decision is made about someone starting work, in order to keep people safe. Quality review systems should be established to make sure that the quality of the service is kept under review and to ensure that peoples views are taken into account in the development of the service. The provider must ensure that monthly visits to the home are carried out and a written report provided, to make sure that any shortfalls in the quality of the service are noted and addressed. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Annette Campbell-Currie 33 Greycoat Street London SW1P 2QF 02079792000 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line - 0870 240 7535 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . It was not clear that a comprehensive assessment is carried out by the home with people interested in moving in before a decision is made about whether or not the service could meet the persons needs. Evidence: There is an admission policy in place that should ensure that assessments are carried out before a decision is made about someone moving to The Old Rectory. We (the Commission) found at the previous inspection that information is gathered from health and social care professionals who have worked with the person and relatives or carers who know the person well. Visits were also arranged so that the person has an opportunity to get to know the home, other people living there and the staff, before they move. The pre-admission process for one person was discussed with a team leader who explained that information and assessments had been obtained before visits were arranged. He said that staff had the opportunity to meet the person and their relatives before a final decision was made. There was no evidence to show that an assessment had been carried out by someone from the home, although the team leader said that an assessment would have been carried out. There was no evidence to show how a decision had been made that the persons needs could be met at The Old Rectory or that there had been a planned admission to the home to help the person settle in. A requirement has been made regarding the preadmission assessment. Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People living in the home do not always have all of their changing needs and personal goals reflected in a care plan. People are supported to make decisions in their daily lives. People are supported in their independence although potential risks are not always assessed and clear guidance is not provided to staff in order to minimise the risk of harm. Evidence: The people who returned surveys with the help of staff indicated that they are happy in the home and have the care that they need. The registered manager has set up small booklets with person centred information that each persons key worker has been helping him or her to complete. These booklets include some information about aspects of the persons life that are important to them and there are drawings and symbols so that it is easier for people living in the home to understand. The case records of three people were looked at in detail and other case records were sampled. Six people living in Segal House have complex needs and behaviours that can present a risk to themselves or others. The case records for one person were looked at in detail and for two other people were sampled. Some of the goals for one person had been documented and reviewed however it was not clear that an updated holistic care plan had been drawn up. Daily record sheets included some details of the persons experience and behaviours at different times of the day. Staff have set up a laminated care passport for three people living in Segal House. This booklet provides key information for people to carry with them so that other people who provide care, for example at the day centre or college, will have clear guidance to Evidence: follow. This document is person centred and is in symbol format for people who can understand this form of communication. There were also photographs of the person and notes about important events in their life. The case records for two people living in parts of the main house were seen. Some personal goals had been noted on both files and there was some evidence to show that the goals had been reviewed. There was no holistic care plan to show that all aspects of peoples care had been assessed and guidance provided to staff so that they would know how to provide care. One person was admitted within the past twelve months and there was no care plan on file. The staff spoken with were clear about peoples needs and during the day staff were providing support in a sensitive manner. The site manager said that reviews are carried out at least every six months. The person whose care is being discussed attends and all the relevant people in their life including the social worker involved with their placement are also invited. A review for one person was being held during the afternoon of the visit. The need for care plans to be in place was discussed with the team leaders and site manager who said that this matter would be addressed. A requirement has been made to ensure that the process for care planning and review are robust so that people receive the care that they need. It was evident that people are supported in their independence and examples were given of people who have been encouraged and supported to move into more independent accommodation in the community. The registered manager said that this option is not suitable for everyone but the home is committed to providing support with independence skills. There was a note on one persons case record that said: X is now able to be left on his own for part of the lesson. The team leader explained that this had been agreed so that the care worker from the home could withdraw and allow the person to interact with his peers and take part more fully in the course. There was no indication on the case files seen that each persons ability to make informed choices or to give consent to a certain course of action had been noted in line with the Mental Capacity Act or when other people would need to make a decision on their behalf. There was some evidence to show that risk assessments had been carried out in aspects of peoples lives where a risk had been identified. The site manager is in the process of reviewing the risk assessments that are in place. Samples of these were seen and did not include detailed guidance for staff about the actions to be taken and the way that risks should be minimised. The case records for people living in Segal House included some guidance about managing behaviours that could present a risk to the person or to others, however these risk assessments and guidelines were not comprehensive and it was not clear that all incidents were being recorded and monitored. Case records in the main house showed some evidence that this is happening for some people but not for all. The site manager said that people have access to specialist advice and support from the local community team for people who have a learning disability. There were letters on file to show that this is the case. Evidence: Feedback from staff indicated that there have been occasions where staff have been put at risk through inadequate guidance about managing behaviours. Some staff were not clear that they had seen the restraint policy, but were aware that the home has a policy of not using restraint. The site manager said that there is a copy of the restraint policy in the staff handbook and that all staff have attended Maybo training that is a method for diffusing aggression and violence. He was advised to ensure that all staff are reminded of these methods to ensure the safety of people living in the home and of staff. A requirement has been made regarding the need for detailed risk assessments to be in place and for these to be reviewed and updated as required. Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People are supported to take part in activities of their choice and to use community facilities. People are supported in their relationships with relatives and friends. Peoples rights and responsibilities are respected and they are provided with a nutritious diet. Evidence: The site manager said in the annual quality assurance assessment form (AQAA) that people living at The Old Rectory have the opportunity to access local community facilities such as cinemas and public houses, swimming, football, horse riding, college and day centres. It was noted that one person is being supported to attend the local church of her choice. There are also some day service activities available in separate buildings on the site. Some of the case records seen had notes of activities that people had chosen to take part in. The communication passports that have been set up for some people included information about their interests and preferred activities. One persons passport said: Im working on cooking and serving meals. The review notes that were seen included comments about peoples goals in terms of their learning and leisure activities. During the day people were able to choose different activities. Some people were out at college, others were being supported by their key workers to carry out domestic tasks, one person was going out for the day to Bognor Regis on the bus with a member of staff. There are links with organisations that set up supported work placements for people. One person is being supported to Evidence: go dog walking. In the afternoon there was a small group of people in the main house sewing, others were in their rooms or using one of the day centre buildings. The atmosphere was relaxed and people clearly had an element of choice during the day. Evening and weekend activities are also arranged and some people attend local clubs and leisure activities. As discussed under the previous outcome area, a holistic plan of care must be produced for each person so it is clear that people are being supported in the lifestyle of their choice. Each person has the opportunity for an annual holiday and people have been to various destinations including the New Forest and the Isle of Wight. The transport provided by the home has recently been changed and two smaller vehicles are now available. Some staff are concerned that the new arrangements could limit peoples opportunity to go out. A charge is made for people to use the homes transport for leisure activities. People are supported to maintain contact with their families and friends. Relatives are invited to attend reviews and to be actively involved in the persons care. People are supported in personal and intimate relationships and the advice and guidance of healthcare professionals is sought if necessary. There was a note on one persons file: X is currently in a relationship with Z. Z is able to visit X but owing to past history they are to be encouraged to spend time in communal areas instead of in Xs room. There is a six weekly menu that provides a varied diet and includes fresh fruit and vegetables. Care staff are responsible for cooking duties in each part of the home. Some people are able to assist in food shopping and meal preparation and this is encouraged. The team leader in Segal House said that people do sometimes take part in cooking activities with staff support. She was advised to include this as part of the activities programme to show that this involvement is encouraged. The main meal of the day is in the evening when everyone has returned from their activities. At lunchtime there are a selection of sandwiches and soup on cold days. Special diets are catered for and in Segal House details of one persons dietary needs were clearly noted and available in the kitchen. The team leader said that she is encouraging more of a family approach at mealtimes and vegetables are provided in bowls on the table so that people are able to choose the amount of food they prefer. Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Peoples personal care needs are not always clearly noted in a plan of their care. Peoples physical and healthcare needs are met. The medication practices do not fully protect people living in the home. Evidence: Staff are provided with guidance about the way to provide personal care as part of their induction. The case records that were seen did not include details about the way people prefer their personal care to be provided. Care plans should include detailed guidance especially where there may be elements of risk for the person or staff supporting them. The site manager said that the home has a good relationship with the local primary care team and also the community team for people who have a learning disability who provide specialist healthcare support. The case records that were read included information about healthcare support that people have required. People have a Health Action Plan that is person centred and one of the staff said this is a useful tool and helps to ensure that people receive the healthcare that they need. The staff who administer medication have all attended training in medication issues so that they have the knowledge that they need. There are storage facilities in each part of the home. The storage facilities in Segal House have now been improved so that medication storage is more secure. In each part of the home two staff administer medication and both sign to say that it has been taken. The records in one part of the home were looked at. There were two books that are both signed by staff however there were a number of gaps in the records. The member of staff said this might have been due to the fact that people Evidence: were away from the home however if this is the case the records should indicate this. The medication for one person was blister packed and the medication in several sections was incorrect. The member of staff said that this would be dealt with immediately but the error had not been noted by other staff or brought to the attention of the manager. The home must ensure that medication records are up to date and the medication is checked to ensure the correct medication is received from the pharmacy. A requirement has been made regarding this matter. Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People cannot be sure their complaints will be investigated and acted upon as there is no system in place for recording the investigation of complaints. There are some systems in place in order to protect people from abuse. Evidence: There is a complaints policy and everyone living in the home has a copy. People who returned surveys with the help of staff knew who to talk to if they had a concern or complaint. The site manager indicated in the AQAA that the home has received one complaint in the past twelve months. Mr Salmon said that there is a book for recording complaints but it could not be found at the time; it was therefore unclear how complaints are managed to show that people are listened to and their concerns and complaints appropriately investigated. A requirement has been made regarding this matter. The home follows the West Sussex multi disciplinary safeguarding policy and procedure. The induction and foundation programmes include an element on safeguarding vulnerable adults and adult abuse. The site manager said that all staff have attended updated training in protecting vulnerable people. Staff spoken with were clear about their responsibilities to report any concerns. The home has reported incidents that have occurred to staff in the social services department and to the Commission. The risk assessments and guidelines for supporting people who have behaviours that could cause a risk to themselves and others were not comprehensive. Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People live in a homely environment. Some areas of the home are in need of refurbishment and cleaning. Evidence: The Old Rectory provides accommodation in four separate units. The Garden Flat, Rafters and the Main House are in the main building and Segal House is in the grounds. The units provide accommodation for people with different levels of independence and support needs. The home is situated on the edge of the village and in a rural setting with beautiful views and the opportunity for local walks. There are staff employed for day-to-day maintenance of all parts of the home. The three units in the main building were comfortable and most areas were well decorated. One bathroom was in need of deep cleaning as there was mould around the bath and there were marks on the ceiling where there had been a water leak from a room above. It was not clear when it is planned that the ceiling will be redecorated as there was no development and maintenance plan available. A member of staff spoken with said that a plan for the future of Segal House has been drawn up. This building is in need of redecoration and communal areas are in need of a deep clean. The shower room, the kitchen, floor covering, walls and furniture were all in need of being cleaned. This must be addressed in the short term to prevent the risk of cross infection and to provide a comfortable and pleasant environment for people to live in. The bedrooms that were seen were in a better state and reflected the personality and interests of people living there. A requirement has been made regarding the need to ensure that all areas of the home are kept clean and well maintained. Possible risks in the home such as radiators that are hot to the touch and the window in the roof in the attic lounge should be assessed and precautions taken if necessary to Evidence: protect people living in the home. There were a number of materials that could be hazardous to health that were not being stored in a lockable facility. A requirement has been made regarding this matter. There is a day centre facility in the same building as the administrative offices and a room in the grounds for art and craft and leisure activities. The grounds are well maintained and staff said people enjoy using the gardens in warm weather. Care staff are responsible for cleaning and laundry duties in all parts of the home. The three units in the main building were clean and the bedrooms seen were comfortable and well decorated. People spoken with said they are happy with their rooms. Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People are supported by staff who are trained and supported to do their job. The recruitment process does not fully protect people. Evidence: At the time of the visit there were sufficient numbers of staff on duty to meet the needs of the people who were at home. Some people were having individual time with members of staff. People living in each unit of the home have staff allocated to work with them although staff sometimes also provide cover in other units if necessary. Feedback from staff indicated that there are not always sufficient numbers of staff on duty when there are a lot of activities. The site manager said that the home does not use agency staff. The recruitment records for three recently appointed staff were seen. Application forms had been completed and two written references had been requested. There was only one reference on two of the files that were seen. The site manager was advised to ensure that there is a robust recruitment procedure in place with two written references in order to help protect people living in the home. A requirement has been made regarding this matter. People do not begin work until an Enhanced Criminal Record Bureau (CRB) check has been received. There was evidence on the recruitment files that CRBs had been obtained. There is an induction programme that includes aspects of learning about providing care for people who have a learning disability. Staff who returned surveys said that they had received the support they needed as part of their induction. There is an ongoing programme of mandatory training and there was evidence to show that staff have attended these training sessions. Evidence: Eleven of the twenty six staff have achieved the National Vocational Qualification (NVQ) at level two or above and five staff are studying for the award. It was not clear whether or not additional specialist training opportunities are available. Staff who returned surveys said they receive the training and support they need to do their job. Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The registered manager is experienced and qualified to run the home. People cannot always be sure that their views will be listened to and taken into account in the development of the home. The systems for monitoring the quality of the service are not sufficiently robust to ensure the health, safety and welfare of people living in the home and of staff. Evidence: The registered manager has been on extended leave and in his absence the site manager has been responsible for the day to day running of the home with the support of Mr Salmon, the responsible individual for the company. During discussions with Mr Salmon and the site manager they agreed that during the absence of Mr Lucas some management tasks and quality monitoring systems had not been carried out. Mr Lucas has now returned to work and will take up his responsibilities for running the home. He has the necessary qualifications and experience to manage the home. There were no quality monitoring systems to show that peoples views have been listened to and taken into account of in the development of the service. The site manager said that the six monthly reviews provide an opportunity for people to discuss aspects of their life in the home that they are not happy with. The site manager also said that normally there are formal quality assurance systems in place. Residents meetings are held regularly and people who are able to could express their views and opinions in this forum. A requirement has been made to ensure the home set up systems to provide opportunities for all people who live in the home or have an interest in the home, to give feedback about the service so that their views can be taken into account in the Evidence: development of the home. Regulation 26 visits have not been taking place and Mr Salmon said that these would be resumed soon. The Regulation 26 visits would provide an opportunity for the quality of the service to be monitored and any shortfalls to be addressed. A requirement has been made regarding this matter. The site manager said in the AQAA that the home meets the requirements of the fire and environmental health departments. Staff have attended training on health and safety matters. There were a number of areas of risk to people living in the home and to staff in terms of behaviours and the environment that have been discussed and need to be addressed. A comprehensive risk assessment process for individuals and the home in general must be drawn up and kept under review to ensure that the health and safety of people living in the home and of staff is protected. Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 1 2 14 A comprehensive assessment 30/04/2009 must be carried out with each person who is interested in moving to the home to make sure that their needs could be met if they were to move in. 2 6 15 A comprehensive care plan 30/04/2009 must be drawn up and kept under review for each person living in the home to ensure that their assessed and changing needs are met. 3 9 13 Risk assessments must be carried out and guidance provided to staff 30/04/2009 to ensure that people living in the home and staff are kept safe. 4 20 13 The registered persons must 30/04/2009 ensure that medication records are up to date and prescribed medication is checked on arrival in the home to ensure that people are kept safe and receive the medication prescribed for them. 5 22 22 The registered persons must 30/04/2009 establish a system for recording and monitoring complaints so that people can be confident that their concerns and complaints will be listened to and acted upon. 6 24 13 Materials that could be 30/04/2009 hazardous to health must be kept in a lockable facility to keep people safe from harm. 7 24 23 All areas of the home must 30/04/2009 be kept clean and reasonably decorated to prevent the risk of cross infection and to provide a pleasant environment for people to live in. 8 34 19 The registered persons must 30/04/2009 ensure that the recruitment process is robust and two written references are obtained for prospective staff before a decision is made about them starting work in order to keep people safe. 9 39 24 The registered person must 31/05/2009 establish systems to monitor the quality of the service and gain feedback from people who live in the home or who have an interest in it to make sure the quality of the service is kept under review and that peoples views are listened to in the development of the service. 10 39 26 The responsible individual for 30/04/2009 the company must carry out monthly visits and provide a written report so that the quality of the service provision is kept under review and any shortfalls are addressed by the home. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone : 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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